Cortisol excess in patients with primary aldosteronism impacts left ventricular hypertrophy
Author(s)
Type
Journal Article
Abstract
Context
Primary aldosteronism (PA) represents the most frequent form of endocrine hypertension. Hyperaldosteronism and hypercortisolism both induce excessive left ventricular hypertrophy (LVH) compared with matched essential hypertensives. In recent studies frequent cosecretion of cortisol and aldosterone has been reported in patients with PA.
Objective
Our aim was to investigate the impact of cortisol cosecretion on LVH in patients with PA. We determined 24-hour excretion of mineralocorticoids and glucocorticoids by gas chromatography–mass spectrometry and assessed cardiac remodeling using echocardiography initially and 1 year after initiation of treatment of PA.
Patients
We included 73 patients from the Munich center of the German Conn’s registry: 45 with unilateral aldosterone-producing adenoma and 28 with bilateral adrenal hyperplasia.
Results
At the time of diagnosis, 85% of patients with PA showed LVH according to left ventricular mass index [(LVMI); median 62.4 g/m2.7]. LVMI correlated positively with total glucocorticoid excretion (r2 = 0.076, P = 0.018) as well as with tetrahydroaldosterone excretion (r2 = 0.070, P = 0.024). Adrenalectomy led to significantly reduced LVMI in aldosterone-producing adenoma (P < 0.001) whereas mineralocorticoid receptor antagonist therapy in bilateral adrenal patients with hyperplasia reduced LVMI to a lesser degree (P = 0.024). In multivariate analysis, the decrease in LVMI was positively correlated with total glucocorticoid excretion and systolic 24-hour blood pressure, but not with tetrahydroaldosterone excretion.
Conclusion
Cortisol excess appears to have an additional impact on cardiac remodeling in patients with PA. Treatment of PA by either adrenalectomy or mineralocorticoid receptor antagonist improves LVMI. This effect was most pronounced in patients with high total glucocorticoid excretion.
Primary aldosteronism (PA) represents the most frequent form of endocrine hypertension. Hyperaldosteronism and hypercortisolism both induce excessive left ventricular hypertrophy (LVH) compared with matched essential hypertensives. In recent studies frequent cosecretion of cortisol and aldosterone has been reported in patients with PA.
Objective
Our aim was to investigate the impact of cortisol cosecretion on LVH in patients with PA. We determined 24-hour excretion of mineralocorticoids and glucocorticoids by gas chromatography–mass spectrometry and assessed cardiac remodeling using echocardiography initially and 1 year after initiation of treatment of PA.
Patients
We included 73 patients from the Munich center of the German Conn’s registry: 45 with unilateral aldosterone-producing adenoma and 28 with bilateral adrenal hyperplasia.
Results
At the time of diagnosis, 85% of patients with PA showed LVH according to left ventricular mass index [(LVMI); median 62.4 g/m2.7]. LVMI correlated positively with total glucocorticoid excretion (r2 = 0.076, P = 0.018) as well as with tetrahydroaldosterone excretion (r2 = 0.070, P = 0.024). Adrenalectomy led to significantly reduced LVMI in aldosterone-producing adenoma (P < 0.001) whereas mineralocorticoid receptor antagonist therapy in bilateral adrenal patients with hyperplasia reduced LVMI to a lesser degree (P = 0.024). In multivariate analysis, the decrease in LVMI was positively correlated with total glucocorticoid excretion and systolic 24-hour blood pressure, but not with tetrahydroaldosterone excretion.
Conclusion
Cortisol excess appears to have an additional impact on cardiac remodeling in patients with PA. Treatment of PA by either adrenalectomy or mineralocorticoid receptor antagonist improves LVMI. This effect was most pronounced in patients with high total glucocorticoid excretion.
Date Issued
2018-12-01
Date Acceptance
2018-07-27
Citation
Journal of Clinical Endocrinology and Metabolism (JCEM), 2018, 103 (12), pp.4543-4552
ISSN
0021-972X
Publisher
Oxford University Press
Start Page
4543
End Page
4552
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism (JCEM)
Volume
103
Issue
12
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30113683
PII: 5063483
Subjects
CARDIAC DYSFUNCTION
CARDIOVASCULAR RISK
CUSHINGS-SYNDROME
DIABETES-MELLITUS
DIAGNOSIS
ECHOCARDIOGRAPHY
Endocrinology & Metabolism
HYPERTENSION
Life Sciences & Biomedicine
MASS
PREVALENCE
Science & Technology
TREATED PRIMARY ALDOSTERONISM
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-08-02